Healthcare Provider Details

I. General information

NPI: 1124305974
Provider Name (Legal Business Name): DR. RANDALL OFORI
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/08/2011
Last Update Date: 11/08/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

215 N 2ND ST
EL CAJON CA
92021-7243
US

IV. Provider business mailing address

5773 MISSION CENTER RD #203
SAN DIEGO CA
92108-4381
US

V. Phone/Fax

Practice location:
  • Phone: 619-401-0761
  • Fax: 619-401-3435
Mailing address:
  • Phone: 619-550-7499
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number62342
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: